We propose to investigate whether children exposed to cocaine in utero are at increased risk of neurodevelopmental and behavioral impairments at 6-7 years of age. If impairments are found, the study will also delineate the causal pathways and mediating factors. Between September 1985 and August 1986, 355 infants born at Harlem Hospital were identified to be exposed to cocaine in utero. The study will draw on 200 of these children and 200 unexposed children matched for age, sex, race, and socioeconomic status and test the association of intrauterine cocaine exposure with neurologic, cognitive, developmental, and behavioral performance at 6-7 years of age. The specific aims of the proposed study are: 1) to describe in these children the spectrum of neurodevelopmental and behavioral disabilities associated with maternal cocaine use during pregnancy; 2) to distinguish between neurodevelopmental and behavioral impairments directly attributable to intrauterine cocaine exposure and those caused by postnatal factors associated with maternal drug use, maternal education and IQ, and family environment; 3) to ascertain whether the association between intrauterine cocaine exposure and neurodevelopmental impairments, if present, is confined to children with intrauterine growth retardation or is indicative of specific damage to the central nervous system independent of somatic and head growth.